title: The unreamed tibial rod in open tibial fractures.
abstract: BACKGROUND
  Open tibial fractures may be managed surgically by either external fixation or the intramedullary rod. If a rod is used, the delayed removal of the locking screws has been advocated to enhance fracture healing. The aim of the present study was to report the results of closed unreamed locked tibial rods in open fractures and evaluate the effect of locking screw removal.
  
  
  METHODS
  Fifty-one patients with open tibial fractures were treated by debridement, intravenous antibiotics, soft-tissue coverage and closed, unreamed, locked intramedullary rods. Forty-six patients were available for review at an average of 13.7 months after surgery.
  
  
  RESULTS
  Union occurred at a mean of 240 days (168.1-312.3 CI). Five (10.8%) patients required bone grafting (two required a bone graft alone, three with exchange rods). Deep infection occurred in three (6.5%) cases, and malunion occurred in seven (15.2%) cases. Locking screw failure occurred in five (11%) cases. There was no significant association between removal of the locking screws, injury type and time to union when comminution was controlled for (P = 0.54).
  
  
  CONCLUSIONS
  These results compare favourably to other methods of treatment for open fractures and suggest that removal of locking screws does not alter the time to union.
authors.affiliation: Department of Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand.
authors.forename: D
authors.initials: D
authors.lastname: Gill
authors.forename: A
authors.initials: A
authors.lastname: Hadlow
mesh_terms: D001863:Bone Screws; D016025:Bone Transplantation; D003646:Debridement; D016267:External Fixators; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D017102:Fracture Healing; D005597:Fractures, Open / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D013978:Tibial Fractures / Q000503:physiopathology / Q000601:surgery*